Русский
The effect of optimization of diuretic therapy on kidney function during circulatory decompensation
DOI: https://dx.doi.org/10.18565/nephrology.2024.3.6-13
Abdullaev O.A., Vereshchak D.P., Dragunov D.O., Sokolova A.V., Rylova A.K., Arutyunov G.P.
1) Pirogov Russian National Research Medical University, Moscow, Russia; 2) City Clinical Hospital named after F.I. Inozemtsev of the Moscow Healthcare Department, Moscow, Russia; 3) Research Institute of Healthcare Organization and Medical Management of the Moscow Healthcare Department, Moscow, Russia
Material and methods. The study included 119 patients with decompensated CHF. Patients were randomized into 2 groups: the control group (loop diuretic therapy) and the main group (combination therapy with SGLT-2 inhibitors and loop diuretics). According to the study protocol, the blood plasma creatinine level with the calculation of the glomerular filtration rate (GFR), daily diuresis and natriuresis were determined.
Results. Against the background of the therapy, from the 2nd day of the study, the level of diuresis in the main group was significantly higher than in the control group (1342.83±159.74 versus 1250.17±134.53; P<0.001). By the 5th day of follow-up, the chance of developing AKI according to the AKIN (OR=5.48, 95% CI 2.22–13.54) and RIFLE (OR=2.45, 95% CI 1.45–5.22) criteria was higher in the control group. At the same time, in the main group, the RIFLE criteria had higher sensitivity, and AKIN – higher specificity. In patients with a low increase in natriuresis (≤90.0 mmol/day), the risk of developing AKI increased by the 5th day of follow-up (OR=5.44, 95% CI 2.40–12.30; P<0.001). The risk of deterioration in GFR was almost 2 times higher in the control group (OR=0.42, 95% CI 0.19–0.93).
Conclusion. Against the background of therapy for CHF decompensation with loop diuretics and SGLT-2 inhibitors, the risk of developing AKI according to AKIN and RIFLE criteria significantly decreased. The AKIN and RIFLE criteria had different sensitivity and specificity, which requires the simultaneous use of both criteria for the diagnosis of AKI. With the use of SGLT-2 inhibitors, the risk of deterioration of SCF decreased, and a high increase in natriuresis was associated with a lower risk of AKI, which proves the nephroprotective properties of SGLT-2 inhibitors in patients during CHF decompensation.
About the Autors
Olim A. Abdullaev – Teaching Assistant at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University. Address: 1 Ostrovityanov st., Moscow, 117997; Cardiologist, City Clinical Hospital named after F.I. Inozemtsev of the Moscow Healthcare Department. Address: 1 Fortunatovskaya st., Moscow,105187; e-mail: abdullayev77177@gmail.com. ORCID: 0009-0000-0048-1623.
Darya P. Vereshchak – Teaching Assistant at the Department of Propaedeutics of Internal Diseases, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Address: 1 Ostrovityanov st., Moscow, 117997; e-mail: daria.vereshak@yandex.ru. ORCID: 0009–0007–8923–1743.
Dmitry O. Dragunov – Cand.Sci. (Med.), Associate Professor at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University. Address: 1 Ostrovityanov st., Moscow, 117997; Research Institute for Healthcare Organization and Medical Management of the Moscow Healthcare Department. Address: 30 Bolshaya Tatarskaya St., Moscow, 115184; e-mail: tamops2211@gmail.com. ORCID: 0000–0003–1059–8387.
Anna V. Sokolova – Cand.Sci. (Med.), Associate Professor Associate Professor at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University. Address: 1 Ostrovityanov st., Moscow, 117997; Research Institute for Healthcare Organization and Medical Management of the Moscow Healthcare Department. Address: 30 Bolshaya Tatarskaya St., Moscow, 115184; e-mail: sokolova2211@gmail.com. ORCID: 0000–0003–0823–9190.
Anna K. Rylova – Dr.Sci. (Med.), Professor, Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University. Address: 1 Ostrovityanov st., Moscow, 117997; e-mail: rylova@ossn.ru.
Grigory P. Arutyunov – Dr.Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University. Address: 1 Ostrovityanov st., Moscow, 117997; e-mail: arut@ossn.ru. ORCID: 0000-0002-6645-2515.
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